Yizkor Book Request Form

Yizkor Book Request Form 2017/5778

Even if you have submitted forms in previous years, a new Yizkor Book Form needs to be submitted each year.

Your Name*

FirstLast

Your Email*

Your Phone*

Remembered by:*

Please indicate how you would like to be listed, i.e. Mr. & Mrs. Ploni, The Ploni Family, John and Jane Ploni, etc.

Changes, Additions or New Entries*

Do you have any changes, additions or new entries to be added to this year's Yizkor Book?

Yes

No

New Entries or Additional Names

If you have a new entries or additional names you wish to have added to your previous entry, please add them below.

Loved One's Name You Wish to Add

FirstLast

Would you like this person to be added to the yearly Yahrzeit list?

Yes

No

How is this person related to you?

Date of Death?

Did your loved one pass before or after sundown?

Before

After

Don't Know

Loved One's Name You Wish to Add

FirstLast

Would you like this person to be added to the yearly Yahrzeit list?

Yes

No

How is this person related to you?

Date of Death?

Did your loved one pass before or after sundown?

Before

After

Don't Know

Loved One's Name You Wish to Add

FirstLast

Would you like this person to be added to the yearly Yahrzeit list?

Yes

No

How is this person related to you?

Date of Death?

Did your loved one pass before or after sundown?

Before

After

Don't Know

Loved One's Name You Wish to Add

FirstLast

Would you like this person to be added to the yearly Yahrzeit list?

Yes

No

How is this person related to you?

Date of Death?

Loved One's Name You Wish to Add

FirstLast

Would you like this person to be added to the yearly Yahrzeit list?

Yes

No

How is this person related to you?

Date of Death?

Did your loved one pass before or after sundown?

Before

After

Don't Know

Loved One's Name You Wish to Add

FirstLast

Would you like this person to be added to the yearly Yahrzeit list?

Yes

No

How is this person related to you?

Date of Death?

Did your loved one pass before or after sundown?

Before

After

Don't Know

Tzedakah (Charity)

An act of tzedakah (charitable giving) in memory of your loved ones is traditional at this time of year and is greatly appreciated. Your donation supports our Temple programs and helps defray the cost of printing the Yizkor Book.

I would like to make a donation in memory of my loved ones.*

Yes

No

Amount of Donation

Chai - $18

Double Chai - $36

Triple Chai - $54

...or Enter an Amount

Payment Information

Payment Method*

Pay by credit card

Pay by check

Please mail a check, made out to "Temple Shalom" with the words "Yizkor Book" in the memo field, to the following address: TEMPLE SHALOM, 215 South Hillside Avenue, Succasunna, NJ 07876-1098.

Would you like to add an amount to cover the credit card convenience fee?